Induction of remission of severe and refractory rheumatoid arthritis by allogeneic mixed chimerism

• Published in: Arthritis and rheumatism Vol. 50; no. 8; pp. 2466 - 2470
• Main Authors: Burt, Richard K., Oyama, Yu, Verda, Larissa, Quigley, Kathleen, Brush, Mary, Yaung, Kimberly, Statkute, Laisvyde, Traynor, Ann, Barr, Walter G.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.08.2004; Wiley
• Subjects: Alemtuzumab; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm - therapeutic use; Antigens, CD - analysis; Antigens, Differentiation, Myelomonocytic - analysis; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - therapy; Biological and medical sciences; CD3 Complex - analysis; Cyclophosphamide - therapeutic use; Diseases of the osteoarticular system; Female; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppressive Agents - therapeutic use; Inflammatory joint diseases; Medical sciences; Middle Aged; Sialic Acid Binding Ig-like Lectin 3; Transplantation Chimera; Vidarabine - analogs & derivatives; Vidarabine - therapeutic use; Refractory; Immunopathology; Chronic; Induction; Mixed; Rheumatoid arthritis; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Remission; Inflammatory joint disease; Severe
• ISSN: 0004-3591; 1529-0131
• DOI: 10.1002/art.20451

This report describes the first allogeneic hematopoietic stem cell transplantation (HSCT) performed for the indication of rheumatoid arthritis (RA). We used nonmyeloablative allogeneic HSCT to treat a 52‐year‐old woman who had treatment‐refractory RA and a poor prognosis (24 swollen and 38 involved joints). She was treated with fludarabine, cyclophosphamide, CAMPATH‐1H, and CD34‐selected HSCT (8 million CD34+ donor cells/kg); the donor was the patient's HLA‐matched, rheumatoid factor–negative sister. One year post‐HSCT, the patient has had no infection except dermatomal varicella‐zoster virus infection and no acute or chronic graft‐versus‐host disease (GVHD). Her RA has remained in remission with no immunosuppressive or immunomodulatory medications. The patient is a mixed chimera, with 55% donor T (CD3+) cells and 70% donor myeloid (CD33+) cells. This is the first published report of allogeneic HSCT performed for the indication of RA. Mixed chimerism has resulted in marked amelioration of RA, without GVHD.